Impact of valvular resistance on aortic regurgitation after transcatheter aortic valve replacement according to the type of prosthesis

Abstract

Background

The impact of aortic valvular resistance (VR) on the degree of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains unclear. The objective of the study was to investigate the relationship between VR and paravalvular AR after TAVR.

Methods

Between August 2007 and December 2015, 708 TAVR patients had sufficient data to calculate VR before the intervention and were eligible for the present analysis. The patient population was dichotomized according to VR. The association between VR and post-TAVR AR was separately assessed by prosthesis type.

Results

Among patients with low VR (LVR; < 238 dynes/cm5), 176 (49.7%) patients were treated with balloon-expandable (BE) valves and 178 (51.3%) patients with self-expandable (SE) transcatheter valves. Among patients with high VR (HVR ≥ 238), 147 (41.5%) and 207 (68.5%) patients received BE and SE, respectively. Baseline characteristics were similar in both groups irrespective of the type of valve. Patients with HVR had a 2.5-fold risk of ≥ moderate post-TAVR AR compared to patients with LVR. Both, HVR (HRadj 2.45, 95% CI 1.33–4.51) and the use of SE (HRadj 3.11, 95% CI 1.66–5.82), emerged as independent predictors of ≥ moderate post-TAVR AR. Moderate or greater post-AR was consistently predicted in patients treated with SE (HRadj 2.42, 95% CI 1.22–4.80) irrespective of the level of VR.

Conclusions

HVR is associated with a nearly 2.5-fold increased risk of moderate or greater post-TAVR AR and is an independent predictor of post-TAVR AR.

Notes

Acknowledgements

None.

Funding

None.

Compliance with ethical standards

Conflict of interest

Prof. Pilgrim has received research grants to his institution from Edwards Lifesciences, Symetis, and Biotronik; has received speaker fees from Boston Scientific; and has received reimbursement for travel expenses from St. Jude Medical. Prof. Windecker has received research grants to his institution from Abbott, Amgen, Boston, Biotronik, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.